Archive for April, 2014

Dead doctors and AAA batteries

April 9, 2014

This one’s about a dead cell
That leaked, and corroded as well
I got over that quirk,
And made the thing work
After only a very short spell

Synopsis: I’m a family practitioner from Sioux City, Iowa. I danced back from the brink of burnout in 2010, and, honoring a one-year non-compete clause, went to have adventures and work in out-of-the-way locations. After jobs in Alaska, New Zealand, Iowa, and Nebraska, I returned home and took up a part-time position with a Community Health Center. I have just returned from a one month locums assignment in Petersburg, Alaska.
In 1989, my then-partner said, “Well, it’s like when you make rounds on Christmas. You start early, you put a Dictaphone in your pocket and you go like mad.”
Sitting at a stoplight on the way home I thought about what he’d said and decided to round as efficiently as possible every day. Later on, when I started doing the hospital work for my group, I started to carry a dictating machine to save time. The alternative required finding a telephone, and entering the following digitally: physician number, dictation type (progress note, discharge summary, etc.), and patient medical record number. As years passed each hospital required more info and developed more pauses before dictation could actually start. Both hospitals shift their equipment every 2-3 years, requiring purchase of a new dictating machine, generally for about $600. With every passing year that purchase brings an increased efficiency over phone documentation.
The last of the handwritten progress notes died two years ago. By then I had figured out how to dictate while walking from patient to patient.
This morning I slipped my hospital-specific digital recorder in my pocket and started rounds at 7:00AM, finding the machine would not turn on. As always, I looked to battery replacement as the first fix, and the pediatric head nurse brought me two new AAA cells, but to no avail. While I grumbled, she took the batteries to the recycling bin, commenting that, as one had leaked, much time must have passed since last I used the machine.
New in mid-January, those batteries saw scant use till late February and no use after; I thought neither period qualified as a long time. I removed the new cells and spotted corrosion on one of the terminals. I went to work with a pencil eraser, cleaning the metal to shininess. I recalled how, in previous years, I repaired so many tiny tapes with scalpel, forceps, and Scotch tape I almost wrote an article, Microsurgery for Microcassettes.
I know batteries go bad, but I have never seen a battery go from new to leaking in less than three months.
Then, with the digital recorder working well, I started on rounds.
At lunch in the Doctors’ lounge, I sat down to a conversation in full swing on the subject of death. One of our ophthalmologists passed away a couple of weeks ago without warning. Then we all remembered the cardiologist who died young on a treadmill, and the orthopedist who died, gratuitously, of colon cancer. In short order we shifted the topic to nature vs. nurture in the realm of colon cancer, heart attacks, alcoholism and cirrhosis.
While the other docs talked, I ate hospital chicken and rice, and thought about batteries leaking and corroding after premature failure. And I rejoiced in the time I’ve spent doing locum tenens.
Carpe diem.

Syphilis and gold: finding what you look for

April 2, 2014

Across the car park I strolled
In the rain and the wind and the cold
The thing I did find
Brought hope to my mind
And turned out to be real gold.

Synopsis: I’m a family practitioner from Sioux City, Iowa. I danced back from the brink of burnout in 2010, and, honoring a one-year non-compete clause, went to have adventures and work in out-of-the-way locations. After jobs in Alaska, New Zealand, Iowa, and Nebraska, I returned home and took up a part-time position with a Community Health Center. I just returned from my second locums trip to Petersburg, Alaska.

On my first Monday back from Alaska I went into the office to catch up on the miscellany that accumulated in my absence. I found 320 clinical items on my electronic desktop along with 78 administrative emails. In the quiet of the early morning, when my body clock should have screamed for sleep, I dug in and started plowing through the items one by one.

About half had to do with bad things that had happened to my patients, requiring hospitalization, while I vacationed. Every admission generated an ER note, a history and physical, progress notes, lab and x-ray reports, and a discharge summary. I could not determine the importance of each item without reading it.

I ran into some surprises.

Three patients received malignant diagnoses, and I judged each cancer gratuitous. None of them did anything to deserve their tumor.

One person’s syphilis tests came up positive. I followed the communications; saw that my partners had done the right thing through the health department notification, the lumbar puncture, and the penicillin injections. I look forward to seeing if the patient’s symptoms improve.

When my father attended medical school, his professors would lecture, “Know syphilis and know medicine,” but since then the frequency diminished to the point where we rarely think about it, and sometime we forget to look for it. Lyme disease brought a resurgence in testing because searching for one justifies testing for the other.

I left the clinic at 1230 to go home for lunch, and as I got into the car, I saw a faint gleam of yellow on the pavement. Smaller than a dime, when I picked it up I saw it had suffered from passing car tires grinding it into the gravel. But it had a milled edge, which marked it as a coin.
At age 9 I found a dollar bill in the street in front of our house, a powerful experience at the time, and even more so because of the large purchasing power it represented in 1959. I started looking for more. One finds things that one looks for.

During med school, the Michigan State school paper published a piece by a student who also found money and who kept track of it; he commented that as inflation eroded the value of money he found more and more. Perhaps because of its lower worth, and perhaps because I keep getting better at spotting it, I find a lot more money than I used to.

When I came back to the office, I stopped in at the pawn shop across the street, and asked my friends there to check the tiny item for gold content, which came, to the surprise of all, as 22 karat; I accepted the spot gold price and walked out a happier man.

I worked through till 530, when I cleared out the last of my electronic communications, thinking about how one find things that one looks for.